Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 56163 | TN |
N | 204F00000X | Transplant Surgeon | A86822 | CA |
N | 208200000X | Surgeon | A86822 | CA |
N | 208600000X | Surgeon | A86822 | CA |
NPI | 1609046069 |
---|---|
Provider Name | Ms. Lea Kiku Matsuoka |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2008 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A868220 | (05) | CA |
00A868220 | BLUE SHIELD PROVIDER NUMBER (01) | CA |